Haematological Malignancy

Question 1

Haematological Malignancies Epidemiology

Answer 1

10% of all human cancers
Occur in all age groups, including children

Adult males are more commonly affected than females.

Question 2

Common cancer in children

Answer 2

Acute Lymphoblastic Leukaemia

Question 3

Age of Hodgkin Lymphoma

Answer 3

Peak incidence between 18-35

Question 4

Median age for MDS

Answer 4

73-74

Question 5

Characteristics of Multipotential haemopoietic stem cell

Answer 5

Cant identify them down the microscope
Can identify them with immunophenotyping
Small population of the bone marrow.
They are pluripotent, and undergo self-renewal

Question 6

Myeloid Malignancies

Answer 6

Red cells, platelets, granulocytes and monocytes

Question 7

Lymphoid malignancies

Answer 7

B-cell to T-cell

Question 8

AML Mutation

Answer 8

Occurs at the hematopoetic cells or the myeloid progenitor cells. Proliferation but without differentiation resulting in the accumulation of useless progenitor cells.

Question 9

ALL Mutation

Answer 9

Occurs at the hematopoetic cells or the lymphoid progenitor cells. Proliferation but without differentiation resulting in the accumulation of useless progenitor cells.

Question 10

Myeloproliferative Disorders

Answer 10

Overproduction but with differentiation resulting in myeloproliferative disorders.

Question 11

Mature Lymphoid malignancies

Answer 11

Occur as the cells pass through the germinal centre of the secondary lymphoid organs.

Question 12

Leukaemia vs Lymphoma

Answer 12

If disease occurs in the bone marrow its called leukaemia

If disease occurs in the lymphoid tissue and solid organs then it is termed lymphoma.

Question 13

Acute Leukaemias

Answer 13

Acute lymphoblastic leukaemia (ALL)

Acute Myeloid Leukaemia (AML)

Question 14

Chronic Leukaemias

Answer 14

Chronic myeloid leukaemia (CML)

Chronic lymphocytic leukaemia (CLL)

Question 15

Malignant Lymphoma

Answer 15

Non-Hodgkin lymphoma (NHL)
Hodgkin lymphoma (HL)

Question 16

Multiple myeloma

Answer 16

Malignany of plasma cells

Question 17

Acute leukaemia process

Answer 17

Leukaemic cells do not differentiate
Bone marrow failure
Rapidly fatal if untreated
Potentially curable

Question 18

Chronic leukaemia process

Answer 18

Leukaemic cells retain ability to differentiate
Proliferation without bone marrow failure
Survival for a few years
Not presently curable without BMT

Question 19

Clinical features of acute leukaemia (bone marrow failure)

Answer 19

Anaemia

• Thrombocytopenic bleeding (Purpura and mucosal membrane bleeding)
• Infection because of neutropenia (predominantly bacterial and fungal)

Question 20

Structure of the Lymph Node

Answer 20

Different lymphocyte populations reside in different areas of the node – B cells in the follicles. T cells in the paracortex and plasma cells in the medulla. Within the B-cell areas different populations – Cells undergoing expansion and selection in the GCs, naive cells in the mantle zone

Question 21

B-cell maturation

Answer 21

B-cell must display appropriate IG to the antigen to survive

Question 22

Lymphoma Presentations

Answer 22

Nodal disease – Lymphadenopathy
> 90% HL present with nodal disease
~ 60% NHL present with purely nodal disease

Extranodal disease:
~ 40% NHL present with an extranodal component

Systemic symptoms: fever, drenching sweats, loss of weight, pruitis, fatigue

Question 23

Localised and painful lymphadenopathy

Answer 23

Bacterial infection in draining site

Question 24

Localised and painless lymphadenopathy

Answer 24

Rare infections, catch scratch fever, TB
Metastatic carcinoma from draining site- hard
Lymphoma-rubbery
Reactive, no cause identified

Question 25

Generalised and painful lymphadenopathy

Answer 25

Viral infections, EBV, CMV, hepatitis, HIV

Question 26

Generalised and painless lymphadenopathy

Answer 26

Lymphoma
Leukaemia
Connective tissue diseases, sarcoidosis
Reactive, no cause identified
Drugs

Question 27

Multiple Myeloma Clinical features

Answer 27

Bone pain and lytic lesions
Hyper viscosity syndrome
Bleeding tendency
Amyloidosis
Renal failure
Recurrent infections
Anaemia